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Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening
by legohead 7y ago
Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done".
At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I'd like to do.
- docker_up 7y agoWhy is this not available? It's ridiculous that we can't do this conveniently. All I read about is new tests and detections, etc and they are only available when it's too late. Things like pancreatic cancer and liver cancer are death sentences and on the rise. Why can't we test for this sooner rather than later?
- ascar 7y agoOut of curiosity: What would you be willing to pay for it? Did you mention you pay yourself? Or do you expect your healthcare provider to cover the thousands of dollars for tests without any indication?
- asdf21 7y agoHospitals don't want people to "pay themselves" when they can bill insurance companies 10x as much.
- iooi 7y agoNot sure why you think that, hospitals charge insurers a lot less than their sticker price. Pricing is usually done as multiples of what Medicare pays, so insurers will build their network and usually have a cap at 2x Medicare. If you are taken to an out-of-network hospital during an emergency, the hospital can charge their regular prices, although this usually gets negotiated down for extended in-patient stays. As an uninsured individual, however, you would be liable for the complete amount, which is a lot more than what the insurance pays.
- lonnyk 7y agoIn my experience self pay is billed at Medicare rates. But I do imagine mileage will vary.
- Someone1234 7y agoThey don't for good reason. Full body scans always turn up unexplained growths which need to be biopsied, causing pain/suffering/complications often resulting in a non-cancerous result. Even the wealthiest individuals with personal doctors rarely perform full body scans for that reason.
- sagebird 7y agoIt’s disgusting how little freedom there is in this area. Even if a doctor wanted to do this for you, they would face criticism from their peers. It’s a form of doublespeak when the messaging is “early detection is key” but you can’t actually use the best tools available until you are sick. The response that people could over react on marginal cases and do more harm if they scan early is incidental- if they scanned more healthy people they would learn how to deal with marginal cases better. I think your only hope is randomly becoming friends with a doctor who self experiments and thinks you are trust worthy enough to let in on it. I don’t even know how possible that is because the drugs administered are probably well controlled, and the machines might be logging information which makes it hard to do privately. Perhaps this is a good candidate for a medical tourist resort start up.
- sjg007 7y agoThe Iatrogenic risk is too high. CT and MRIs have false positives or reveal benign tumors/conditions that have to be investigated which result in additional testing, surgery etc... So in the absence of symptoms or known genetics / family history it is just not done. But fear not, in the next 20 years we will likely have blood based tests for finding some early cancers though. You should ask yourself why do you want to get checked for cancer.
- asdf21 7y agoShouldn't everyone want to be checked for it? I spend 10000x more time and effort monitoring the health and performance indicators of my servers compared to my body, it's astoundingly ignorant that we aren't more honed in on early detection for all sorts of issues.
- buildzr 7y agoFalse positives in the case of server monitoring are extremely rare and easy to detect when they do happen. Can you imagine if your server monitoring runs once per minute and randomly fails 1/100 times? You'd be getting panic-inducing server is down emails many times per day. Such server monitoring would produce little to no value as you'd quickly ignore them as noise, just like you should avoid doing more tests like this on your body. Additionally, CTs in particular produce ionizing radiation and increase your risk of cancer. If monitoring your server increased the risk of it failing, would you still want monitoring on it?
- sxg 7y agoThe health and performance indicators of your servers are reliable and (relatively) accurate. Analogous indicators for the human body are much less so. False positive and false negative rates for many different kinds of tests/exams are uncomfortably high. In cases where patients have other signs/symptoms suggesting an underlying issue, it does make sense to use these tests and exams, but in otherwise healthy patients, you may do more harm than good.
- pkaye 7y agoBeing on dialysis, I get around 20 blood tests every month. Waiting for the results is nerve-wracking because I have a few tests that are borderline and I'm expecting the worst. There is also some random fluctuation which can cause me worries. The results are certainly useful to stay healthy but at the same time, for a day or two around the test time, I just can't concentrate on plan for anything.
- nradov 7y agoA CT scan involves some radiation exposure so it would be unethical for a doctor to order one unless you're at high risk of cancer or have some other symptoms.
- frisco 7y agoI did Health Nucleus which includes a whole body MRI (no ionizing radiation exposure) and a bunch of other stuff geared towards looking for cancer. Apparently Prenuvo in Vancouver is considered the best now. It’s a few $k and insurance doesn’t cover it, but there are a bunch of options for self-pay to be more aggressive in primary care / health surveillance. This stuff about “overtesting” and “iatrogenic risk” is silly. It’s one of the biggest misconceptions in medicine today. Every test has a sensitivity and a specificity and must be interpreted accordingly. Not doing that properly is a doctor problem not a test problem. In terms of spurious findings, it is usually possible to stack diagnostics until the answer becomes clear. There are lots of things between a CT and a biopsy.
- irq 7y agoI'd like to learn more about companies like Prenuvo, is there some online community somewhere where you heard Prenuvo was the best? Or some other resource where I can learn? If so I'd appreciate a link, thanks!
- frisco 7y agoI hear about these things through the grapevine in San Francisco. There's a subculture there that's all about optimizing their healthcare with as much data as possible; having seen what's possible, you really come to believe that primary care as it exists today for most people under 55 is basically a scam. I have two personal friends who are probably only alive now because they were more proactive about getting health data! (No joke, abnormalities found on MRIs turned out to be early stage cancer.) And a bunch more friends who are overall much healthier than they were before because now they have numbers to move. (Or numbers that move faster: for example, using Dexcom G6s has been catching on as a hack to lose weight because the gradient is much better behaved than a scale.) I also saw one case where someone was diagnosed with cancer and they put together a research team to help guide their treatment... and they ended up developing all this experimental medicine for him which, while ultimately unsuccessful, is thought to have added about a year of life. (Did you know that the FDA can grant single-patient INDs over the phone within one day? [0]) There's a lot of accumulated knowledge out there on how much better healthcare can be for motivated patients who can afford to pay for some of it out of pocket, but it's seen as pretty contrarian, so not discussed that openly. (Just see the other comments in this thread about how "overtesting" is a dangerous waste of resources...) I don't know of an online community or blog that collates all this info well, but Peter Attia's blog/podcast is a good place to start: https://peterattiamd.com/ https://peterattiamd.com/ [0] https://www.fda.gov/drugs/investigational-new-drug-ind-application/physicians-how-request-single-patient-expanded-access-compassionate-use https://www.fda.gov/drugs/investigational-new-drug-ind-appli...
- Randypea 7y agoThere are a number of different blood tests for these 30 cancer types, each of which can detect a high likelihood of cancer. Each blood test tells you YES or NO. Then this type of radiotracer scan will tell you WHERE. Toray Japan is developing this test: https://asia.nikkei.com/Business/Companies/Japan-s-Toray-seeks-fast-approval-for-single-drop-cancer-blood-test https://asia.nikkei.com/Business/Companies/Japan-s-Toray-see... Until this is available you could ask your PCP for the corresponding blood test for all the types of cancer you want to check.
- nradov 7y agoBlood tests really don't tell you yes or no. They give you quantified biomarker concentrations which are correlated with certain types of cancer. In some cases the diagnosis is clear, but often it's more of a gray area.
- Randypea 7y agoTrue, if the level found is 150% of normal, it's a problem. In my case, I was misdiagnosed for 10 years. When my docters finally ran the test for the right biomarkers, they found levels 50 times normal. So maybe the tests need wider margins to screen out false positives.
- nkrumm 7y agoMD here. It's "not done" because it could hurt you. Here's the Bayesian argument: - Let's assume a lab test (or imaging test) has a 1% false positive rate and 100% sensitivity (that would be pretty good for many tests and imaging modalities!). - The cancer you screening for has a 1% incidence as well (low-ish, for the sake of argument). - Therefore the chance that a "positive" scan would be due to a false positive or a true cancer would be equivalent (i.e., the Positive Predictive Value is 50%). If we did this at population level, we'd be massively overtreating and over-biopsy-ing... not the desired outcome.
- asdf21 7y agoThis would also force advancements in the field re: distinguishing false positives. More information is better than less, imo.
- Waterluvian 7y agoFalse positives can be actively harmful. Unnecessary biopsies lead to unnecessary infections and stress and such.
- nostromo 7y agoCancer is also harmful, particularly if not found early.
- SketchySeaBeast 7y agoI assume every doctor's visit sees you getting checked for every type of condition every time, or do you want your doctor to play the odds and only look for things you're likely to have? There's plenty of harmful ways to die, and you'll find they don't check for most of them until they have a decent reason.
- dannykwells 7y agoNo, this is the wrong argument. What would happen is, eventually people just wouldn't believe any of these tests and they would become useless, even when they did reach a high level of PPV. Also see the point about biopsies - definitely not non-invasive, often require surgery. Also cost - you're now looking at 5-10k extra charges.
- madengr 7y agoA CT is about 1 rem of exposure. It takes 2500 rem to cause a cancer (the linear approximation). So every 2500 CT scans you have given someone cancer.
- superdimwit 7y ago...this assumes we're all the same person....
- mschwaig 7y ago1 rem of radiation exposure causes cancer with a probability of 0.05 % according to Wikipedia[1]. It seems such a scan causing a cancer would be due to a very low probability event on a cellular level. From that point of view the above calculation looks reasonable. It is only after that when the additional macroscopic influences caused by a specific person's body/environment come into play that your point applies. This was interesting so I started from that 0.05 % per 1 rem and did the inverse calculation. For 2500 rem this gives about 1-(1-0.0005)^2500 = 71 % probability of developing cancer. I also made a plot from 0 up to 10000 REM[2]. The incident rate seems to be pretty much approaching 100 % around 10k, so our results differ by about a factor of 4. [1]https://en.m.wikipedia.org/wiki/Roentgen_equivalent_man#cite_ref-ICRP103_3-0 https://en.m.wikipedia.org/wiki/Roentgen_equivalent_man#cite... [2]https://www.wolframalpha.com/input/?i=1+-+(1+-+0.0005)%5Ex+from+x%3D0+to+10000 https://www.wolframalpha.com/input/?i=1+-+(1+-+0.0005)%5Ex+f... EDIT: The initially mentioned 2500 rem figure must be over a long enough time for the exposure not to cause more immediate issues than cancer.
- madengr 7y agoYes, long time, as 2500 would kill you quickly. I should have said linear hypothesis. I’m going off what learned in a online physics lecture on radiation effects. Right at the beginning of this: https://youtu.be/nDviu3DLDRk https://youtu.be/nDviu3DLDRk 2500 people at 1 rem each yields one cancer. 250 people at 10 rem, again 1 cancer 25 at 100 rem, again 1 cancer, but they now have ARS (acute radiation sickness). This is interesting since one would think ARS would definitely cause cancer, but it’s only 1/25, whereas 1/3 of people will develop cancer. 8.3 people at 300 rem, which is the 50% threshold for death from ARS, but still 1 cancer. I’d think 2500 CT scans/year is a typical number for a hospital. Can they be sued for causing that single incidence of cancer?
- LinuxBender 7y agoI think you will have a hard time getting anyone to scan you. Currently the tests are expensive and doctors have to argue with insurance companies enough as it is, for patients that exhibit symptoms. The default answer is that the extra scanning will increase risk to you, which really isn't true if you compare that radiation to other forms of radiation you get throughout the day. 10 millisieverts is nothing. [1] You can compensate for this easily by increasing your bodies own cell autophagy. In the mean time, you should research anti-cancer foods and foods that cause cancer and increase cell autophagy. Preventative natural medicine has many benefits beyond just preventing and treating cancer cells. Obvious foods to stay away from are anything with sugar (and all its forms, there are many) and glyphosates (good luck with that, everything is sprayed with them). Cance cells live off glycogen and oxygen. Anti-cancer foods include aged garlic extract, bioavailable enhanced curcumin, all the cruciferous vegetables, sulforaphane extract from broccoli sprouts, fatty fish, apples, beans, to name a few. For those with metabolic syndrome which increases risk of cancer, there is Berberine which is anti-tumor (natural alternative to the prescription metformin) I am not a doctor. This is unpopular nutritional advice for naturally reducing all cause mortality. [1] - https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct https://www.fda.gov/radiation-emitting-products/medical-x-ra...
- Gatsky 7y agoOther comments have spoken about why random screening is a bad idea. But the real problem is the tests we have just aren’t good enough. What are you hoping to diagnose with a CT scan? If you don’t smoke, the most common cancer you’ll get is breast/prostate and colon. CT scans are close to useless for detecting those cancers (If you do smoke then there is some evidence for CT screening). Also note that image based screening has a resolution of around 5-10mm (CT and MRI closer to 5mm, nuclear medicine closer to 10mm). Once a cancer is this size, we are already talking about over 100 million cancer cells in your body. You will need surgery, and possibly chemotherapy and radiotherapy to eliminate these cells once it gets to that size. What you actually want is prevention, not early detection.
- markus92 7y agoJust FYI: CT/MR can nowadays be performed at sub millimeter resolution pretty much everywhere with up to date equipment, even out of plane.
- Gatsky 7y agoThis doesn’t change anything, I’m sure you know that the smaller the lesion the harder it is to determine what it is, and they are impossible to biopsy or resect.